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Minimally invasive BE screening cost effective in non-GERD population

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PHILADELPHIA — Implementing minimally invasive screening strategies might make population-based Barrett’s esophagus screening regardless of GERD status more feasible, according to research presented at the American College of Gastroenterology Annual Meeting.

“Current [BE] screening recommendations are currently centered around patients with [GERD],” Sarmed S. Sami, MBChB, PhD, of the Mayo Clinic in Rochester, Minnesota, said during his presentation. “However, up to 40% of patients with [BE] or esophageal adenocarcinoma deny having those symptoms, and therefore may be missed in a GERD-centric screening program.”

Using decision analytic methods, Sami and colleagues aimed to evaluate comparative cost effectiveness of currently available, minimally invasive tests using recently published data on prevalence, accuracy, screening uptake and costs.

Investigators analyzed six screening methods:

• Upper endoscopy;

• Cytosponge with TFF3 biomarker;

• Sponge on a string (SoS) with methylated DNA biomarkers;

• Breath testing (E-Nose);

• Hospital-based transnasal endoscopy (hTNE); and

• Mobile-based transnasal endoscopy (mTNE).

Using a Markov model, researchers simulated a hypothetical cohort of 100,000 individuals aged at least 50 years and followed them for 40 years, checking for various health outcomes, including no BE, BE, dysplasia, cancer and death. They calculated mean costs for each strategy and assessed them using quality adjusted life years (QALYs).

In their general population analysis, Sami and colleagues found that mean costs ranged from $120 (mTNE) to $554 (E-NOSE). Mobile-TNE was the most dominant strategy, but cytosponge and SoS tests had the lowest incremental cost-effectiveness ratios ($3,333 and $5,000, respectively).

Although mTNE was the most dominant strategy, Sami and colleagues found that it was not widely utilized or evaluated beyond one center. However, the cytosponge and SoS strategies both performed well in the analysis.

“In a general population of 50-year-olds irrespective of GERD presence, the capsule sponge-based strategies appeared to be costs effective for Barrett’s screening,” Sami said. “But participation rates for these strategies in a screening population need to be better defined.” – by Alex Young

Reference : Sami S, et al. Abstract 29. Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 5-10, 2018; Philadelphia.

Disclosure: Sami reports no relevant financial disclosures. Please see the study abstract for all other authors relevant financial disclosures.